Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.     

The Nature,Timing, and Symptom Trajectories of Dropout From Transdiagnostic and Single-Diagnosis Cognitive-Behavioral Therapy for Anxiety Disorders

Dropout from psychotherapy is common and can have negative effects for patients, providers, and researchers. A better understanding of when and why patients stop treatment early, as well as actionable factors contributing to dropout, has the potential to prevent it. Here, we examined dropout from a large randomized controlled trial of transdiagnostic versus single-diagnosis cognitive-behavioral treatment (CBT) for patients with anxiety disorders (n = 179; Barlow et al., 2017). We aimed to characterize the timing of and reasons for dropout and test whether participants who dropped out had different symptom trajectories than those who completed treatment. Results indicated that overall, the greatest risk of dropout was prior to the first treatment session. In single-diagnosis CBT, dropout risk was particularly elevated before the first session and after other early sessions, whereas in transdiagnostic CBT, dropout risk was low and stable before and during treatment. Participants most often dropped out due to failure to comply with study procedures or dissatisfaction with or desiring alternative treatment. Results from multilevel models showed that trajectories of anxiety symptoms did not significantly differ between dropouts and completers. These findings suggest that there may be specific time windows for targeted and timely interventions to prevent dropout from CBT.     

Development of adolescence‐limited,late‐onset,and persistent offenders from age 8 to age 48

This article investigates the life success at ages 32 and 48 of four categories of males: nonoffenders, adolescence‐limited offenders (convicted only at ages 10–20), late‐onset offenders (convicted only at ages 21–50), and persistent offenders (convicted at both ages 10–20 and 21–50). In the Cambridge Study in Delinquent Development, 411 South London males have been followed up from age 8 to 48 in repeated personal interviews. There was considerable continuity in offending over time. Persistent offenders had the longest criminal careers (averaging 18.4 years), and most of them had convictions for violence. Persistent offenders were leading the most unsuccessful lives at ages 32 and 48, although all categories of males became more successful with age. By age 48, the life success of adolescence‐limited offenders was similar to that of nonoffenders. The most important risk factors at ages 8–18 that predicted which offenders would persist after age 21 were heavy drinking at age 18, hyperactivity at ages 12–14, and low popularity and harsh discipline at ages 8–10. The most important risk factors that predicted which nonoffenders would onset after age 21 were poor housing and low nonverbal IQ at ages 8–10, high neuroticism at age 16, and anti‐establishment attitudes and motoring convictions at age 18. It was suggested that nervousness and neuroticism may have protected children at risk from offending in adolescence and the teenage years. Aggr. Behav. 35:150–163, 2009. © 2009 Wiley‐Liss, Inc.     

School adjustment in adolescence for previously rejected,average and popular children

Background: Earlier research shows that peer‐rejected children are at risk of a wide range of subsequent adjustment difficulties in different social contexts, as, for example, in school. Aims: This study investigated the academic performance and school adjustment in adolescence of children with different peer status in middle childhood. Sample: Age 15 boys and girls (N=90), who at age 10 and 11 were sociometrically rejected, popular, or of average popularity in their school class. Methods: School marks, intelligence scales, and self‐reports were used as adjustment measures. School dropout rate for boys was also included. Results: The academic performance and intelligence level of rejected boys and girls were short of the standards of children from the other status groups, while the scores of popular boys and girls were of superior standard. There were some slight indications that rejected girls (but not rejected boys) had negative attitudes towards school and schoolwork, and that popular girls had positive school attitudes. The school dropout rate of rejected boys was much higher than that of other boys. Conclusions: The results show that the rejected children are a risk group for school problems also over a long period of time. Considering the important developmental aspects of the adolescence years, there appear to be good reasons, therefore, to worry about the future adulthood adjustment of peer‐rejected children.     

The impact of self‐confidence on the compromise effect

This research reports an investigation into whether the personality aspect of self‐confidence affects the compromise effect. We hypothesize that highly self‐confident people have greater certainty in making decisions and are more attracted to risk‐taking, which makes them less likely to choose the safe or middle option in a large choice set. The three studies involved are conducted using between‐ and within‐subjects experimental designs. Various product categories are used to generalize the findings. Study 1 looks at purchasing decisions and utilizes three scales of self‐confidence, risk preference, and uncertainty; it demonstrates that consumers with high self‐confidence are less likely to choose a compromise option due to high certainty in their decision‐making. Study 2 discovers that people with low self‐confidence are more likely to choose the middle option in a risky condition than in a nonrisky condition. Study 3 decomposes self‐confidence into general and specific self‐confidence, and reveals that people with low general self‐confidence and low specific self‐confidence are more likely to choose the middle option.     

Participation and Attrition in a Coping Skills Intervention for Adolescent Girls with Inflammatory Bowel Disease

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.     

Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy

The current study employed machine learning to investigate whether the inclusion of observer-rated therapist interventions and skills in early sessions of psychotherapy improved dropout prediction beyond intake assessments. Patients were treated by postgraduate clinicians at a university outpatient clinic. Psychometric instruments were assessed at intake and therapeutic interventions and skills in the third session were routinely rated by independent observers. After variable preselection, an elastic net algorithm was used to build two dropout prediction models, one including and one excluding observer-rated session variables. The best model included observer-rated variables and was significantly superior to the model including intake variables only. Alongside intake variables, two observer-rated variables significantly predicted dropout: therapist use of feedback and summaries and treatment difficulty. Although not retained in the final prediction model, the observer-rated use of cognitive techniques was also significantly correlated with dropout. Observer ratings of therapist interventions and skills in early sessions of psychotherapy improve predictors of dropout from psychotherapy beyond intake variables alone. Future research could work toward personalizing dropout predictions to the specific dyad, thereby improving their validity and aiding therapists to recognize and react to increased dropout risk.     

Child and Caregiver Dropout in Child Psychotherapy for Trauma

This study focused on the identification of variables collected at baseline assessments that predict children and caregivers who are at risk for dropout from treatment. A sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress was utilized for this study. Multinomial logistic regression analyses indicated that caregiver and child age, the child's externalizing behaviors, and the child and caregiver's acknowledgment of posttraumatic stress symptoms significantly predicted premature dropout from treatment. Clarification of child and caregiver characteristics that increase the risk of dropout allows for the identification of families in need of additional support to stay in treatment.     

Additive effects of social and non‐social attention during infancy relate to later autism spectrum disorder

Emerging findings from studies with infants at familial high risk for autism spectrum disorder (ASD), owing to an older sibling with a diagnosis, suggest that those who go on to develop ASD show early impairments in the processing of stimuli with both social and non‐social content. Although ASD is defined by social‐communication impairments and restricted and repetitive behaviours, the majority of cognitive theories of ASD posit a single underlying factor, which over development has secondary effects across domains. This is the first high‐risk study to statistically differentiate theoretical models of the development of ASD in high‐risk siblings using multiple risk factors. We examined the prediction of ASD outcome by attention to social and non‐social stimuli: gaze following and attentional disengagement assessed at 13 months in low‐risk controls and high‐risk ASD infants (who were subsequently diagnosed with ASD at 3 years). When included in the same regression model, these 13‐month measures independently predicted ASD outcome at 3 years of age. The data were best described by an additive model, suggesting that non‐social attention, disengagement, and social attention as evidenced by gaze following, have a cumulative impact on ASD risk. These data argue against cognitive theories of ASD which propose that a single underlying factor has cascading effects across early development leading to an ASD outcome, and support multiple impairment models of ASD that are more consistent with recent genetic and neurobiological evidence.     

Infant ERPs separate children at risk of dyslexia who become good readers from those who become poor readers

Dyslexia is heritable and associated with phonological processing deficits that can be reflected in the event‐related potentials (ERPs). Here, we recorded ERPs from 2‐month‐old infants at risk of dyslexia and from a control group to investigate whether their auditory system processes /bAk/ and /dAk/ changes differently. The speech sounds were presented in an oddball paradigm. The children were followed longitudinally and performed a word reading fluency test in second grade. The infant ERPs were subsequently analyzed according to high or low reading fluency in order to find a neurophysiological precursor of poor reading fluency. The results show that the fluent reading children (from both the at‐risk and the control group) processed the speech sound changes differentially in infancy as indicated by a mismatch response (MMR). In the control group the MMR was frontally positive and in the fluent at‐risk group the MMR was parietally positive. The non‐fluent at‐risk group did not show an MMR. We conclude that at‐risk children who became fluent readers were better at speech processing in infancy than those who became non‐fluent readers. This indicates a very early speech processing deficit in the group of later non‐fluent readers.     

The fit between dignity self‐construal and independent university norms: Effects on university belonging,well‐being,and academic success

Universities struggle with students’ low well‐being and high dropout rates. High (compared to low) fit between students’ self‐construal and perceived university norms might help to prevent these problems. A strong dignity self‐construal (i.e., the understanding that one's worth is independent of others) is adaptive if university norms stress independence. The more a university norm is perceived as stressing independence, the better the fit for students with a strong (vs. weak) dignity self‐construal. Thus, if students with a strong dignity self‐construal perceive a university norm as stressing independence, they should develop a greater sense of belonging to the university and, in turn, experience higher well‐being, more motivation, and lower dropout intention. A longitudinal study with two measurement points conducted with students from 18 universities (N = 719) provided support for these predictions. This underlines the relevance of the fit between student and (perceived) school characteristics for the higher education sector.     

School counselors' accuracy in identifying adolescents at risk for dropping out

School counselors were asked to identify, using qualitative judgments alone, adolescents who they believed were at moderate risk for dropping out. These students were then administered a dropout prediction scale. Results indicated that the school counselors accurately identified potential dropouts. The paper concludes with a discussion of the ties between dropout identification and consultation with teachers.     

The prevalence of stalking of psychological therapists working in primary care by current or former clients

The prevalence of being a victim of harassment or stalking among the general population of the UK is held to be 11.8 per cent. There has been speculation that the prevalence rate would be higher for psychological therapists, as they could be at risk from their own clients. This study analysed the prevalence of job‐related experiences of harassment or stalking in a postal survey of psychological therapists who worked in primary care. The results showed a prevalence rate of more than twice the national average at 24 per cent. The stalkers, who were equally male or female, fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. The implications of these findings for training and practice are discussed.     

Activity involvement among suicidal and nonsuicidal high-risk and typical adolescents

The purpose of this study was to compare weekly activities among four groups of randomly selected high-risk and typical high school students: (1) potential dropouts at suicide risk, (2) typical youth at suicide risk, (3) potential dropouts not at suicide risk, and (4) typical youth not at suicide risk. Of the 1,286 participants, 39.4% of the high-risk and 30.1% of typical high school students screened in at suicide risk. Weekly activity comparisons across the four groups showed that suicide-risk adolescents, regardless of potential dropout status, engaged in more solitary activities on weekdays and weekends than did their nonsuicide risk peers. High-risk potential dropout youth engaged in less homework and more social activities during weekdays and weekends than did the typical high school students. These results provide important insight into the weekly activity involvement of at-risk youth while helping to gain a better understanding of suicide-risk adolescents. Implications of these findings are discussed for identifying youth at risk for suicidal behavior and for prevention programming.     

Predictors of Dropout in Cognitive Processing Therapy for PTSD: An Examination of Trauma Narrative Content

Dropout rates in trauma-focused treatments for adult posttraumatic stress disorder (PTSD) are high. Most research has focused on demographic and pretreatment predictors of dropout, but findings have been inconsistent. We examined predictors of dropout in cognitive processing therapy (CPT) by coding the content of trauma narratives written in early sessions of CPT. Data are from a randomized controlled noninferiority trial of CPT and written exposure therapy (WET) in which CPT showed significantly higher dropout rates than WET (39.7% CPT vs. 6.4% WET). Participants were 51 adults with a primary diagnosis of PTSD who were receiving CPT and completed at least one of three narratives in the early sessions of CPT. Sixteen (31%) in this subsample were classified as dropouts and 35 as completers. An additional 9 participants dropped out but could not be included because they did not complete any narratives. Of the 11 participants who provided a reason for dropout, 82% reported that CPT was too distressing. The CHANGE coding system was used to code narratives for pathological trauma responses (cognitions, emotions, physiological responses) and maladaptive modes of processing (avoidance, ruminative processing, overgeneralization), each on a scale from 0 (absent) to 3 (high). Binary logistic regressions showed that, averaging across all available narratives, more negative emotions described during or around the time of the trauma predicted less dropout. More ruminative processing in the present time frame predicted lower rates of dropout, whereas more overgeneralized beliefs predicted higher rates. In the first impact statement alone, more negative emotions in the present time frame predicted lower dropout rates, but when emotional reactions had a physiological impact, dropout was higher. These findings suggest clinicians might attend to clients’ written trauma narratives in CPT in order to identify indicators of dropout risk and to help increase engagement.     

Multifactorial pathways facilitate resilience among kindergarteners at risk for dyslexia: A longitudinal behavioral and neuroimaging study

Recent efforts have focused on screening methods to identify children at risk for dyslexia as early as preschool/kindergarten. Unfortunately, while low sensitivity leads to under‐identification of at‐risk children, low specificity can lead to over‐identification, resulting in inaccurate allocation of limited educational resources. The present study focused on children identified as at‐risk in kindergarten who do not subsequently develop poor reading skills to specify factors associated with better reading outcomes among at‐risk children. Early screening was conducted in kindergarten and a subset of children was tracked longitudinally until second grade. Potential protective factors were evaluated at cognitive‐linguistic, environmental, and neural levels. Relative to at‐risk kindergarteners with subsequent poor reading, those with typical reading outcomes were characterized by significantly higher socioeconomic status (SES), speech production accuracy, and structural organization of the posterior right‐hemispheric superior longitudinal fasciculus (SLF). A positive association between structural organization of the right SLF and subsequent decoding skills was found to be specific to at‐risk children and not observed among typical controls. Among at‐risk children, several kindergarten‐age factors were found to significantly contribute to the prediction of subsequent decoding skills: white matter organization in the posterior right SLF, age, gender, SES, and phonological awareness. These findings suggest that putative compensatory mechanisms are already present by the start of kindergarten. The right SLF, in conjunction with the cognitive‐linguistic and socioeconomic factors identified, may play an important role in facilitating reading development among at‐risk children. This study has important implications for approaches to early screening, and assessment strategies for at‐risk children.     

The animate–inanimate distinction in preschool children

This study examined the development of the animate–inanimate (A–I) distinction in relation to other taxonomic categories in early childhood. Four‐ and 5‐year‐old children were administered two tasks measuring knowledge of taxonomic categories at various levels of inclusiveness. Across both matching‐to‐sample and object sorting tasks, the same pattern of categorization development was observed. Mastery of basic‐ and superordinate‐level categories was demonstrated by 4 years of age. Although 5‐year‐old children performed above chance on A–I level categories, their abilities were not as mature as those of adults. Results of this study support and extend previous studies investigating the development of children's understanding of naïve biology during the preschool years.     

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute,Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.     

The development of spatial category representations from 4 to 7 years

Representation of spatial categories was assessed in 4‐ to 7‐year‐olds. Across nine spatial categories (In, On, Under, In Front, Behind, Above, Below, Left, and Right), children were asked to pick the odd‐one‐out from four images, three of which displayed the same spatial relationship between two objects, and one which showed a different spatial relationship. Results support our proposed model of spatial category representation. Children progressed through three levels of understanding: from rigid (level 1), to abstract (level 2) to broad (including non‐prototypical category exemplars) (level 3) understanding of spatial category membership. This developmental pattern was common to all spatial categories, and the ages at which children reached each level varied across categories, in line with the order in which category representations emerge in infancy.     

Mental Health among Youth in South Australia: A Survey of Flourishing,Languishing, Struggling,and Floundering

The Complete State Model of Mental Health was used to describe the prevalence of flourishing, languishing, struggling, and floundering in life in a sample of young South Australians (n = 3,913; 13–17 years, 52% female). Categorisation was based on the relative proportion of mental health and mental illness symptoms reported on standardised measures and the association of these categories to health‐risk behaviour. Variability in categories and health‐risk behaviour due to gender or region was investigated. Results indicated that a disturbingly small proportion of adolescents (<50%) were flourishing in life, that poorer states of mental health were associated with increased health‐risk behaviour, and that the propensity to engage in health‐risk behaviour did vary by gender and region. The current study extends the platform from which positively focused mental health strategies can be tailored and launched to meet the mental health needs of adolescents.